Therapy: Cleaning Up the Blood

When the kidneys fail to work and there is no hope of starting them up again, the resulting uremia is fatal in about three weeks. A hospital would seem to be the only place where victims could get adequate care. Hundreds of hospitals are equipped with artificial kidneys which are costly to install, even more costly to operate. For each of the 100 U.S. patients who regularly get lengthy treatments, usually twice a week, the cost is $10,000 a year. But now the artificial kidney is moving out of the hospital, into the home. It promises to cut costs in half.

Water from the Faucet. Two afternoons each week, a Boston lawyer leaves his office early and goes home to bed. His rolled-up left sleeve discloses two plastic tubes permanently implanted in his forearm, one set in a vein, the other in an artery. Their outside ends are connected so that blood flows freely through them. A physician from Boston’s Peter Bent Brigham Hospital takes the lawyer’s blood pressure. In his bedroom, near the bathroom, is a waist-high tank of stainless steel equipped with an electric motor and pump, an array of tubes, and a hose that is hooked onto the bathroom faucet.

Meanwhile, a nurse from the Brigham has put sterile coils in the tank’s bath of dialysate (filtering solution) and added chemicals. She uses about l½ pints of the lawyer’s blood, stored from the last treatment, to prime the coil. Then she connects a thin hose from the artificial kidney to the artery tube in his arm. He bleeds a little to finish the priming and the nurse hooks another hose to his vein tube. That completes the liquid circuit, and she switches on the machine. When all is going well, the doctor leaves.

For four to six hours, while the lawyer can doze or read briefs, the blood from his forearm artery flows through the plastic coils in the bath. Metabolic poisons that should have been excreted in his urine have accumulated in his blood. (Uremia patients urinate, but pass only a small volume of weak, watery liquid.) In the artificial kidney, the poisons are leached out of the blood through the walls of the cellophane tubing and into the chemical bath.

Time for Homework. Dr. John P. Merrill, head of the Brigham’s cardiorenal section, says in the A.M.A. Journal that he sees no need for a physician to be in constant attendance, provided he is within reach by telephone. He thinks wives can be trained to take the nurse’s place, and in two cases involving Brigham patients, they have already begun to do so.

Dr. Belding H. Scribner of the Seattle Artificial Kidney Unit, which houses a monster machine for treating 15 patients at once under hospital conditions (TIME, April 24), is also treating two patients at home by essentially the same technique as that used in Boston, though the equipment differs in detail. One of his patients is a high school girl who leaves classes early twice a week so that her mother can dialyze her, while she does her homework.